Monday, March 04, 2013

CDC Study Shows that Electronic Cigarette Use is Growing Among Smokers and Helping Some Smokers Quit, But Without any Increasing Appeal to Nonsmokers

According to a national survey conducted by the Centers for Disease Control and Prevention (CDC), there was a tremendous increase in electronic cigarette use among smokers from 2010 to 2011 along with a large increase in the proportion of former smokers who reported having used electronic cigarettes, but without any increase in use by never smokers, suggesting that these products show promise as part of a national strategy for smoking cessation and reduction.

The study reported that ever use of electronic cigarettes among smokers increased from 9.8% in 2010 to 21.2% in 2011. Ever use of electronic cigarettes among former smokers increased from 2.5% to 7.4%. Ever use among never smokers remained steady at 1.3%.

In a press release accompanying the article, CDC Director Tom Frieden, MD, MPH, stated: "E-cigarette use is growing rapidly. There is still a lot we don’t know about these products, including
whether they will decrease or increase use of traditional cigarettes."

Also in the press release, director of the Office on Smoking and Health at CDC - Dr. Tim McAfee - stated: "If large numbers of adult smokers become users of both traditional
cigarettes and e-cigarettes — rather than using e-cigarettes to quit
cigarettes completely — the net public health effect could be quite
negative."

The Rest of the Story

Despite the CDC's concerns about the use of electronic cigarettes among youth to cigarette smoking initiation, there is no evidence that such a phenomenon is occurring. This study shows that despite the tremendous growth in awareness, publicity, and marketing of electronic cigarettes, there has been no recent increase in the ever use of these products among adult nonsmokers.

The study also demonstrates a tremendous increase in ever use of electronic cigarettes among smokers. Furthermore, it demonstrates that a large proportion of former smokers have used electronic cigarettes. This doesn't prove that they used the electronic cigarettes successfully to achieve cessation, but it is consistent with this hypothesis.

Combined, these results add further support to the evidence that electronic cigarettes are a promising strategy to enhance smoking cessation and smoking reduction.

Interestingly, despite what these results actually suggest, the CDC is presenting them in a most negative light. The CDC director emphasizes that we don't know whether the use of electronic cigarettes will increase or decrease the use of traditional cigarettes. However, there are only two ways electronic cigarettes could increase the use of traditional cigarettes: (1) if smokers who would otherwise have quit switch to electronic cigarette and tobacco cigarette dual use; or (2) if nonsmokers begin using electronic cigarettes and then initiate cigarette smoking.

There is absolutely no evidence that #2 is occurring. Electronic cigarettes are not popular among youth nonsmokers and in prior surveys, it has been difficult to identify even a single youth nonsmoker who uses electronic cigarettes.

There is also no evidence that #1 is occurring. Most electronic cigarette users are attracted to these products because they want to cut down or quit smoking but have failed to do so using other available smoking cessation products, like drugs. It is unlikely that these smokers would have quit smoking completely had it not been for electronic cigarettes.

The director of the Office on Smoking and Health is incorrect in stating that: "If large numbers of adult smokers become users of both traditional
cigarettes and e-cigarettes — rather than using e-cigarettes to quit
cigarettes completely — the net public health effect could be quite
negative."

Actually, the net public health effect could only be negative if large numbers of adult smokers who would otherwise have quit smoking completely become dual users of traditional cigarettes and e-cigarettes. If large numbers of adult smokers who would not have quit smoking completely reduce their cigarette consumption by substituting electronic cigarettes for some of their tobacco cigarettes, then the net effect on public health will be massively positive, as there would be a substantial decline in cigarette consumption.

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About Me

Dr. Siegel is a Professor in the Department of Community Health Sciences, Boston University School of Public Health. He has 32 years of experience in the field of tobacco control. He previously spent two years working at the Office on Smoking and Health at CDC, where he conducted research on secondhand smoke and cigarette advertising. He has published nearly 70 papers related to tobacco. He testified in the landmark Engle lawsuit against the tobacco companies, which resulted in an unprecedented $145 billion verdict against the industry. He teaches social and behavioral sciences, mass communication and public health, and public health advocacy in the Masters of Public Health program.